Priapism

Kondisi yang jarang pada ereksi yang berkepanjangan. Pasien akan merasakan nyeri,
tidak ada kegairahan dan keinginan sexual. Gangguan idiopathic pada 60% kasus dan
40% kasus terkait dengan penyakit seperti : leukemia, tumor pelvic, inflamasi pada
pelvic), trauma penil, trauma spinal cord, pengobatan trazodon. Saat ini, injeksi
intracavernosus untuk impotensi adalah penyebab yang paling umum. Meskipun tipe
idiopatik sering dikaitkan dengan rangsangan seksual berkepanjangan, kasus priapisme
karena penyebab lainnya tidak terkait dengan kegembiraan seksual psikis

priapism may be classified into high and low-flow type. high-flow type priapism (nonischemic)
usually occurs secondary to perineal trauma, which injures the central penile arteries and result
in loss of penile blood-flow regulation. Aneuryms of one or both central arteries have been
observed. Aspiration of penile blood for blood-gas determination demonstrates high oxygen and
normal carbon dioxide levels. Arteriography isuseful to demonstrate aneurysms that will respons
to embolization : erectile function is usually preserved
Priapisme dapat diklasifikasikan ke dalam jenis aliran tinggi dan rendah. Priapism tipe arus tinggi (nonischemic)
biasanya terjadi akibat trauma perineum, yang melukai arteri penis pusat dan mengakibatkan hilangnya regulasi
aliran darah penis. Aneuryms dari satu atau kedua arteri sentral telah diamati. Aspirasi darah penis untuk penentuan
kadar gas darah menunjukkan kadar oksigen dan oksigen dioksida yang tinggi. Arteriografi berguna untuk
menunjukkan aneurisma yang akan merespons embolisasi: fungsi ereksi biasanya dipertahankan

The patien with low flow priapism (ischemic) usually present with a history of several hours of
painful erection. The gland penis and corpus spongiosum are soft and uninvolved in the process.
The corpora cavernosa are tense with congested blood and tender to palpation. The current the
ories regarding the mechanism of priapism remain in debate, but most authorities believe the
major abnormality to be physiologic obstruction of the venous drainage. This obstruction cause
buildup of highly viscous, poorly oxygenated blood (low O2, high CO2) within the corpora
cavernosa. If the process continues for several days, interstitial edema and fibrosis of the corpora
cavernosa will develop, causing impotence.
Ischemic priapism must be considered a urologic emergency. Epidural or spinal anesthesia can
be used. The sludged blood can then be evacuated from the corpora cavernosa through a large
needle place through the glan. The addition of adrenergic agents administered via intracavernous
irrigation has proved helpful. Monitoring intracavernous pressure ensures that recurrence is not
imminent. Multiple wedges of tissue can be remove with a biobsy needle to create a shunting
fistula between the galns penis and corpora cavernosa. This technique, which has been very
successful, provides an internal fistula to keep the corpora cavernosa decompressed. To maintain
continuous fistula drainage, pressure should be exerted intermittenty (every 15 minutes) on the
body of the ppenis. The patient can do this manually after he has recovered from anesthesia.
If the shunt described fails, another shunting technique may be used used by anastomosing the
superficial dorsal vein to the corpora cavernosa. Other effective shunting methods are corpora
cavernosa. Other effective shunting